Low back pain: To scan, or not to scan? That is the question


Many of my osteopathy patients with low back pain (LBP) often ask me whether or not a scan is required, but the decision to scan is not always straight forward, so let’s clear a few things up. Firstly, there are several different types of scanning procedures used to investigate back pain, we’ll focus on the two most commonly employed, namely X-Ray and MRI scanning. Briefly, X-ray is useful to show anything related to bone tissue in the spine, which consists of mainly the pelvic bones and the individual vertebra (spinal bones). As a rule, X-ray does not show any of the ‘soft tissues’ of the spine, namely the muscles, ligaments, nerves, intervertebral discs or cartilage. In contrast, MRI (which is short for magnetic resonance imaging) provides much clearer and detailed images of all structures related to the spine (bone, nerves and soft tissues). Both forms of scanning can be very use in specific musculoskeletal conditions.

One common misconception is that a scan (either X-ray or MRI) will be useful in most cases of LBP. However, for common ‘non-specific’ or ‘mechanical’ LBP (such as a sprain or strain to the muscles or ligaments of the back), a scan is rarely required or in fact even very helpful. This is because there is a very poor relationship between what is seen on a scan and an individual’s symptoms (pain and disability). For example, a perfectly healthy, pain free person may have an MRI scan which shows they have damage to their intervertebral discs or perhaps wear and tear of their spinal joints. In contrast, a person with severe back pain may have an MRI which shows little-to-no damage to the spinal structures. This is paradox of LBP. This scenario is frequently seen at the clinic and is supported by recent research which shows that in a group of normal pain free people, 90% had degenerative discs and 30-40% had disc bulges or joint degeneration. Furthermore, research also suggests that scanning people with non-specific LBP actually has negative consequences as it causes patients to needlessly worry and focus on the scan results, and put them in a negative frame of mind, which then negatively impacts their recovery.

Scanning is only required when there are clinical signs that suggest more serious causes of spinal pain or that there is significant damage to nerves in the area, however this is rare.

So in summary,

  • Scans are rarely required or helpful in most cases of LBP.
  • Scans can be helpful if there are specific clinical signs which suggest a more complicate or serious cause (this is rare).
  • Most cases of LBP will resolve in 4-8 weeks.
  • Keeping active, advice from a health professional or a short course of manual therapy/spinal manipulation (such as osteopathy, chiropractic or physiotherapy), are usually all that’s required to help episodes of LBP resolve quickly.

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